1. Conservative Surgeries
For Genital Prolapse

2. Operative Treatments of Prolapse
The type of surgery offered to the patient with
prolapse depends on the –
A) Age of the patient
B) Her desire to retain the uterus either for
reproductive or menstrual reasons
C) Her menstrual history
D) Her general condition
E) Degree of uterine prolapse

4. List of conservative surgeries
Conservative procedures are which preserves the
menstural and childbearing functions.
1) Colporrhaphy ( anterior/ posterior)
2) Fothergill’s repair(Manchester operation)
3) Shirodkar’s procedure
4) Abdominal sling operation
a)Abdominocervicopexy
b)Shirodkar’s abdominal sling operation
c)Khanna’s abdominal sling operation

5. Anterior colporrhaphy
Principle -An anterior repair is a vaginal surgery to
correct a cystocele, when the "upper" wall of
the vagina that is in contact with the bladder is
sagging down, or coming outside of the vaginal
opening.
Indications – a)cystocele
b)Cystourethrocele

6. Steps –
a)Traction is given to the cervix to expose the anterior
vaginal wall.
b) An inverted T- shaped incision is made , starting with a
transverse incision in the bladder sulcus and through
its mid point ,vertical incision extended up to the
urethral opening.
c) The vaginal walls are reflected to either side to expose
the bladder and vesicovaginal fascia.
d) The overlying vesicovaginal fascia is tightened and the
excess vaginal wall excised to correct the laxity, and
vaginal wall sutured.

7. Complications - Risks of colporrhaphy include potential
complications associated with-
1.Anesthesia,
2.Infection,
3.Bleeding,
4.Injury to other pelvic structures,
5.Dyspareunia (painful intercourse),
6.Recurrent prolapse,
7. Failure to correct the defect.

8. Posterior colporrhaphy
Principle –
A posterior repair is a vaginal surgery to correct a
rectocele, when the "lower" wall of the vagina that is in
contact with the rectum is bulging into the vagina, or
coming outside of the opening of the vagina.
Indications –
a) Rectocele
b) Repair of deficient perineum

9. Steps –
a) This is done by making a triangular or diamond-shaped
incision, and removing some of the extra skin of the wall
of the vagina
b) After this skin is removed, the strong tissues underneath
are brought together with strong stitches.
c) The lax vagina over the rectocele is excised , and the
rectovaginal facia repaired after reducing the rectocele.
d) The approximation of the medial fibers of the levator ani
helps to restore the caliber of the haitus urogenitalis
, restore the perineal body and provide an adequate
prenium.

10. Complications-
One possible risk of this surgery is that the
vaginal opening may become narrow with scar
tissue, and there may be some discomfort
with sexual activity. The rest of the
complications are same as that of Anterior
Colporrhaphy.

11. Shirodkar’s procedure
Principle –
Cervical cerclage , also known as a cervical stitch, is used for the
treatment of cervical incompetence ,a condition where the
cervix has become slightly open and there is a risk of
miscarriage because it may not remain closed throughout
pregnancy and may even cause prolapse.
Indications –
a)To avoid miscarriage and preterm delivery
b)Prolapse of uterus
c) Prolapse of vagina
d)Maintainence of fertility

12. Steps –
a) Anterior colporrhaphy is performed as usual
b) Attachment of mackenrodt ligament to the cervix on each
side is exposed
c) The vaginal incision is then extended posteriorly round the
cervix
d) The pouch of douglus is opened , uterosacral ligaments
identified and devide close to the cervix
e) The stumps of these ligaments are crossed and stiched
together in front of cervix
f) A high closure of the peritonium of the pouch of douglus is
carried out.

13. Complications-
1. Cervical Dystocia with failure to dilate requiring
Cesarean Section
2. Displacement of the cervix
3. Injury to the cervix or bladder
4. Cervical rupture (may occur if the stitch is not
removed before onset of labor)
5. Infection of the cervix
6. Infection of the amniotic sac (chorioamnionitis)

14. Fothergill’s repair
Principle –
A vaginal operation for prolapsed uterus consisting
of cervical amputation and parametrial fixation of
the cervical ligaments of the uterus. Also called
Manchester Operation.
Indications –
a)Cervical elongation
b)2nd and 3rd degree Prolapse
c)Preservation of menstrual and childbearing
capabilities.

15. Steps –
a)The surgeon combines an anterior colporraphy with amputaion of
cervix
b) Then sutures the cut ends of the meckenrodt ligament in front of
the cervix
c) Covers the raw area of the amputed cervix with vaginal mucosa
d) Follows it up with a colpoperineorrhaphy (suture of the ruptured
vagina and perineum)
Complications-
1) Incompetent cervical os.
2)Habitual abortion or preterm deliveries
3) Excessive fibrosis may lead to cervical stenosis and distocia during
labour
4) Heamatometra
5) Recurrence of prolapse may occur following vaginal deliveries in
some cases

16. Abdominal sling operations
Principle-
the objective of this operation is to buttress the weakened supports (
mackenrodt and uterosacral ligaments) of the uterus by providing a
substitute in the form of nylon or dacron tapes , used a slings to support
the uterus
Indications-
1) 3rd or 4th degree uterine prolapse
2) Women who are desirous of retaining their childbearing and menstrual
functions
3) Enterocele
Operation in common practice include –
1)Abdomino cervicopexy
2)Shirodkar’s abdominal sling operation
3) Khanna’s abdominal sling operation

17. Steps -
1)Opening of the abdominal wall through a low transverse
supra pubic incision deepened down up to the rectus sheath
2)Two musculofascial slings are elevated from the midline
outwards and laterally up to the lateral border of the rectus
abdominus muscle on either side
3) The peritoneum is opened in the mid line , and the uterus
brought up into view
4)The uterovesical fold is incised ,and the bladder mobilised
from the front of the uterine isthmus
5)Presently the surgeons uses a 12” long mersilene/nylon tape
to provide a new artificial suppport for the uterus
6) The tape is fixed at its mid point to the uterine isthmus
anteriorly, and its lateral ends brought out retropritoneally
between the two leaves of the broad ligament
7) The ends of the tape are now fixed to the aponeurosis of
the external oblique muscle of the abdominal wall

18. Complications-
1) Intraoperative bladder or urethra injury
2) Infections associated with screw or staple points
3) Rejection of sling material from a donor or
erosion of synthetic sling material
4) Infection,
5) Bleeding,
6) Injury to other pelvic structures,
7) Dyspareunia (painful intercourse

19. Thank you!!!